Ask the School Nurse: Parents' Top 9 Questions for Back to School

The back-to-school season can arouse dread in parents and kids alike, especially when it comes to sickness and health. Aside from marking the end of summer's lazy days, "back to school" signals the start of a crazy time for many families, a time during which we scramble to update immunizations, re-establish more structured eating, television, and bedtime routines, and keep our kids healthy.

To help you plan a healthy and anxiety-free school year, we spoke with Jean Grabeel, a registered and certified school nurse who coordinates health services for 24,000 students at the Springfield public school district in southwest Missouri. She answers nine questions on the minds of parents readying themselves for a new school year -- and a new cold and flu season.

For a happier, healthier transition, don't wait until the night before school starts to set up sleep and nutrition routines that might not have been strictly enforced over the summer. Try setting bed and wake-up times a few weeks before school starts and gradually adjusting them to be earlier as the first day approaches.

Also, take a trip to the school in advance so children know where their classroom is. Give them a chance to meet their teacher, the school nurse, and other staff, if possible. If your child has a chronic health condition requiring medication, such as asthma or diabetes, a food allergy, or any type of health care concern requiring special attention, contact the school nurse early to put a plan in place well in advance of the first day of school.

Immunizations, which are a very necessary part of the back-to-school routine, can be a little scary for kids, but you don't need to drag them kicking and screaming to the doctor's office. Ease kids' worries by talking with them about the health benefits of vaccines so they understand why the shots are important and are less anxious about getting them. Make sure immunizations are current and ask your health care provider about other immunizations that might be recommended but not required, such as the flu vaccine.

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2. How do illnesses spread among school children?

Colds and flu are typically spread from person to person from respiratory droplets. Viruses enter the body through the eyes, mouth, or nose. A sneeze can spray thousands of infectious particles into the air at 200 miles per hour, and they can travel 3 feet. If children don't cover their mouths and spray other children or an object, such as a doorknob, and other children touch it and wipe their noses or mouths, they're more likely to get sick.

3. What's the best way to help my child prevent picking up an illness at school?

It's important to teach kids to wash their hands before eating and after playing outside and using the restroom. Hand washing is one of the best ways to prevent illness. If parents enforce that at home, we'll reinforce it at school. Talk to your kids about covering their mouths with a tissue when they cough and sneeze, and send them to school with a bottle of antiviral hand gel and instructions to use it often. Also, the CDC recommends the flu vaccine for kids ages 6 months and older.

4. Can I send my child to school if he's not feeling well?

If your child has a temperature higher than 100 degrees, body aches, and extreme sleepiness or is coughing or vomiting, you need to keep him home until he is free of those symptoms for 24 hours. If he's not really sick, but something seems off, let the school nurse know and ask her to monitor your child.

5. What if there is a sibling at home who is sick?

Tell the school nurse, "Joey's brother has been out with an illness. Joey's not having any symptoms, but I'm just letting you know." Then, reinforce healthy hygiene practices at home and school, and make sure all your kids are getting enough sleep.

A cold often begins with a sore throat that lasts for a day or two and is accompanied by sneezing, sniffling, and, in some cases, a temperature. It usually lasts for no more than a week, but symptoms can linger longer.

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The flu usually comes on fast and includes more intense symptoms such as body aches and soreness, fever, headache, sore throat, and congestion that can last about a week. Kids with the flu don't want to get up and play. Flu can cause gastrointestinal symptoms, such as nausea and vomiting (swine flu tends to be associated with vomiting and diarrhea).

7. How should I treat my child who has a cold or flu?

Make sure your child gets plenty of rest and fluids, such as water or 100% fruit juice, especially if your child has diarrhea or vomiting. Giving her a pain reliever, such as acetaminophen or ibuprofen (not aspirin), for fever is OK if taken as directed. But don't give your child an over-the-counter cold remedy without first talking to your health care provider. Many of these medicines are no longer recommended for children. If symptoms continue after three days and your child is still running a fever, call your health care provider. It's also helpful to contact the school nurse and ask what she sees going on at school. Is she noticing strep throat? Other illnesses? Ask what you should be watching for. And call your health care provider if the symptoms persist beyond three days, your child's fever is higher than 101 degrees, or your child has ear pain, a worsening cough, or a sinus-type headache.

8. If my child has been immunized for flu and the kids around her haven't, will her immunity be less effective?

No, your child's immunity is not going to be compromised because other children haven't been vaccinated. But there is a certain herd phenomenon with vaccine-preventable illnesses, such as the flu. That means that the more children who are vaccinated, the fewer kids will become sick and miss school.

9. What should my child's school be doing to protect kids from germs?

Ask what the school is doing to keep the grounds clean. Particularly during flu season, we make sure drinking fountains and other surfaces are cleaned several times a day. Also ask what the school is doing about prevention and if it has a plan for what to do during a flu outbreak. Is it providing classroom instruction about hygiene and making sure kids follow through? Will it be offering a flu vaccine on site? Ultimately, it's important to remember that a sanitized room is clean only until you and I walk into it.

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Getting Your Kids Off to a Healthy School Start

Need some more basic tips on keeping kids healthy? Follow these guidelines:

Healthy lunches for kids

• Primary colors. Load up their lunchboxes with a colorful mix of fruits and vegetables to keep them energized and ready to learn. Apples, pears, berries, dried fruit, baby carrots, cauliflower, and edamame are easy to pack -- and fun to eat.

• Fluid motion. Drinking plenty of fluids helps active children stay hydrated. But not all drinks are created equal. According to the American Academy of Pediatrics, kids who drink one can of soda a day increase their obesity risk by 60%. Offer water and limit soft drinks (some can pack 150 calories per 12-ounce can).

• The whole truth. Whole grains are an important part of a healthy diet for kids. Offer whole grain, low-sugar cereals at breakfast and low-sodium whole grain snack bars or crackers in their lunch box. Try making sandwiches with whole grain bread (look for "100 percent whole wheat" on labels to get the most grains).

• Dairy queen. Strengthen their bones and brains with nonfat or low-fat dairy foods, including yogurt and flavored milk (choose products with no more than 30 grams of sugar).

• Class action. Don't assume your child is getting enough physical activity at school. Giving kids a chance to move and get their heart rates up before studying makes it easier for them to learn. Ask your child's teacher about having the class do jumping jacks, run in place, and other quick exercises in between classroom activities.

• Power hour. Make sure your kids run around for at least an hour each day. Don't have a full hour for exercise? Try short 15-minute bursts of running, jumping, or games that encourage these activities to keep them interested and active.

• Family affair. Busy families tend to skip physical activities together. Bond with your kids and boost the whole family's health by planning family bike rides, walks, or other exercise you can all do together.

Stress reduction for children

• Slow start. Want to help make the start of school easier -- and halt the moans and groans before they begin? Set up back-to-school routines early and ease kids into them gradually. Push back bed and wake-up times by 15 minutes each week, for example.

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• Open sesame. Encourage your child to talk about the anxiety he may feel about starting school. Remind him he's not the only kid feeling nervous and that teachers are there to help.

• Meet and greet. Take your child to visit the school so she knows where her room is and can meet her teacher, the school nurse, and other staff before school starts.

• Buddy system. A friendly face can reduce first-day jitters. Have your child ride the bus or meet on the playground with a friend.

• Scare tactics. Talk to your child about bullying and give him tools to cope: Stand tall, look the bully in the eye, and firmly tell him, "I don't like what you're doing."

• Hands on. Adopting good hand-washing habits is the best way to avoid illness. Teach your child to rub her hands for at least 20 seconds with soap and warm water before eating and after using the restroom and playing outside.

• Cover up. Teach your child to sneeze and cough into a tissue or the inside of her elbow to keep infectious droplets from spraying into the air and making other kids sick.

• Home works. Most kids catch colds or flu from an under-the-weather classmate. Give your child the rest she needs and her classmates a break by keeping her home when she doesn't feel well.

• Lighten up. Carrying a backpack shouldn't be a workout for your child. Pack the bag as lightly as possible, with heavier items in the center compartment. The load should never be more than 10% to 20% of her body weight.